Significance of AHI number

Hi Pugsy. Some days I sleep without waking and on other days I wake up early and would not be able to sleep. I did my sleep test 3 years ago and was diagnosed with Ahi 41. They recommended Cpap but I did no take it seriously. This year I decided to take control of things and bought s9 autoset. Don't know if I had to do a sleep study again. How should the pressure graph be.

Some people find that the wide variations in pressure changes disturb sleep. That's why I asked about sleep quality. I can sleep through changes of 8 to 20 and never know they happen but other people find that a change from 8 to 9 or 10 wakes them up.

It's hard to say what is driving your pressures but they do vary widely and often. It's doing the job of keeping the AHI down though. I am scratching my head here on what to offer and even do we really need to do anything but watch things for a while.
If you are sleeping soundly some nights and not others then I don't know how much of an impact (if any) the pressure changes are having on your sleep quality.

What does your Flow limitation graph and snore graph look like? Much of anything showing? Your machine will respond to FLs and snores with more pressure.

I can't seem to get a sense of any pattern to the widely changing pressures..like we might see for supine sleeping or REM stage sleep. It doesn't seem to fit REM stage sleep pattern at all which could explain higher pressure needs.

The widely changing pressures may just be something you need for some reason and at times you need a lot of pressure and if it were me I wouldn't want to be using pressures that high all the time in cpap mode which would eliminate the wide variations and I don't know if we really need to.

On the off chance that the pressure changes themselves are a factor in sleep quality (causing the wake ups at times) then we might consider more minimum pressure again so that the machine is doing a better job preventing and not in "fix it" mode so much but technically going by AHI the need isn't supported but maybe it would be supported by FLs or snores.

So I am sort of scratching my head here. I don't know that anything really needs to be "fixed" in terms of the pressure changes. If you were reporting horrible sleep quality and tons of wake ups all the time then yeah we have something that needs to be fixed but normally if that was the case you wouldn't be telling us you sleep soundly some nights.

Thanks Pugsy. I will wait for some more days and see if the variation is coming down. When I get up I feel refreshed but through the course of the day I feel more tired. For the first one week it was really good. I had so much energy.its just that its not the same nowadays. I will continue this treatment come what may be. Hoping that over the course of time it will get better. Also I have stared my exercises and want to be careful on what I eat. This forum is indeed a great help.

When you get a chance can you post an image of the flow limitation graph? It might offer some clues as to why you don't feel go great now. It might also just be the honeymoon phase is over but wouldn't hurt to look at things while giving it "time".

Hi. I just uploaded my data after increasing my minimum pressure. Please provide me your inputs.

What is your usual sleeping position when you start out the night?

Looks like the pressure increase at the beginning of the night may have been in response to snores which are slightly increases at the same time. Pressure line otherwise after the initial increases seems to settle down a bit and not fluctuate so wildly.

How did you sleep last night? How do you feel today?
All in all the report, at least on paper, looks quite decent. Leak line is super good with only minimal spikes which may be a mask reseating thing...did you wake often to fiddle with mask?

Hi Pugsy. I sleep on my back at the beginning. Also I felt little better than the previous night although not like what I was for the first week. I dont remember waking up more often in the night. May be 2 times last night. But still its much better than without the machine.

It's common for our OSA to get "worse" or need more pressure to prevent the airway collapse when sleeping on our back.
Some people will try to totally avoid back sleeping for this reason but I don't normally advocate that unless pressure needs are hugely different and the pressures themselves become a problem.
Sometimes we just can't always stay on our side for any number of reasons and using artificial means to promote side sleeping (tennis balls or whatever) will mess up our sleep quality a whole lot more than supine sleeping does.
I figure we are using the machine...let it do its job and prevent the airway collapse no matter what position we want to sleep in. It's not like we can't go without the machine anyway unless someone has zero apneas on their back and want to go to extraordinary measures to stay off their back. My OSA is worse in REM sleep. I sure can't or don't want to limit REM sleep.

If you are sleeping well and feeling decent...just let the machine do its job. It seems to be handling things quite well.
If not sleeping well and feeling decent..then a little more minimum pressure might be needed to give the machine a little better head start in dealing with what happens when you are on your back.

Or if you wish you can try to stay on your side more. That's hard to do sometimes. I have a friend who wanted to try to stay off her back so she did the tennis balls in the backpack thing. Went to sleep on her side just fine..woke up in the AM flat on her back and from the looks of the reports she likely had spent at least half the night there. Backpack with about a dozen tennis balls was still underneath her. She didn't wake up when she moved to her back. The idea is that with tennis balls we wake up from the discomfort and hopefully will then go back to side sleeping. Well......waking up a gazillion times is pretty much guaranteed to totally screw up sleep quality.
My friend and I just decided to deal with it and in her case it just required a little more pressure and she could sleep in any position she wanted.

So supine sleeping likely explains a good bit of your varying pressures. If it isn't a problem..no need to fix it.
Up to you to decide if it is a problem or not and/or if a fix would be worse than the problem.

When all the numbers and graphs looks good but still you dont fell like rested fully. What could be the reasons. Is it just that it will take some time.

Sometimes we just need time to feel as good as the reports say we should feel but while "giving it time" it hurts nothing to look at other possible culprits. Often it isn't one single thing that makes or breaks things when someone hasn't experienced the "miracle".

Meds...one thing we look at. Do you take any meds of any kind (even OTC)? If so, what name, strength and when you take it?
Hours of sleep?
Are those hours of sleep fragmented with wake ups for any reason?
Do you have any other health issues?
What symptoms are you having that you wish to see improved? Fatigue? Drowsiness and need to nap during the day? Exactly what symptoms are you having?
Have you had a general physical exam lately with the routine labs? Thyroid checked?
Ever had your vitamin D blood level checked?
Hormone levels?

In terms of your reports...the AHI looks good but the pressure is varying widely. Some people find that those pressure changes can negatively affect sleep quality and anything that affects sleep quality can affect how we feel during the day.
So you might want to think about maybe trying a very tight range in apap mode or using cpap mode. See if those widely varying pressures are impacting sleep quality. So that's something to consider. You will likely have to use 2 or 3 cm more minimum and have the maximum 1 cm above that minimum if you do a tight APAP range (I would go up slowly though and not make a big jump all at once)...or use cpap mode at 13 or so..again go up slowly....to see if pressure changes themselves are a disruption to sleep quality. We don't always remember awakenings or arousals but they can sure mess with how we feel.

Do you have any typical OSA symptoms that might have improved to some extent? My first symptoms to go away with optimal therapy were the morning killer headaches and nocturia. I didn't see general energy levels increase all that much until months later and I discovered that my need to nap during the day was related to how many hours of sleep I got...less than 7 hours of sleep and my butt was dragging.
Sometimes improvements are gradual. We read about people having the one night miracle but those people are actually in the minority. Most of us it took some time and the improvements were gradual.

So while we have to "give it time"...don't have much choice in that regard but while we are giving it time it hurts nothing to do additional detective work to see if there is anything else that might be impacting things.

I always start with meds question first.